Design, Synthesis, Docking Studies and Molecular Dynamics Simulation of New 1,3,5-Triazine Derivatives as Anticancer Agents Selectively Targeting Pancreatic Adenocarcinoma (Capan-1)

On the basis of remarkable anticancer profile of s-triazine nucleus, a new series of 2-methoxy-4-(3-morpholino-5-(arylamino)phenoxy)benzaldehyde derivatives 11 a-u was prepared and evaluated for in vitro antiproliferative activity against eight diverse human cancer cell lines (Capan-1, HCT-116, LN229, NCI-H460, DND-41, HL-60, K562 and Z138). Compounds 11 o, 11 r and 11 s were the most potent anticancer agents on pancreatic adenocarcinoma (Capan-1) cell line with IC50 value of 1.4, 5.1 and 5.3 μM, respectively, while compounds 11 f, 11 g, 11 k, 11 l and 11 n displayed selective activity against the pancreatic adenocarcinoma (Capan-1) cell line with IC50 values of 7.3-11.5 μM. These results indicate that derivative 11 o may serve as a promising lead compound for the ongoing development of novel antiproliferative agents. The docking studies were conducted to predict the interactions of derivative 11 o with putative protein targets in pancreatic adenocarcinoma (Capan-1) cell line, specifically the prenyl-binding protein PDEδ. Furthermore, the analysis of the molecular dynamics simulation results demonstrated that complex 11 o promoted a higher stability to the prenyl-binding protein PDEδ.

Predominance of MGMT promoter methylation among Pakistani glioblastoma patients

BACKGROUND

Glioblastoma multiforme (GBM), the most prevalent subgroup of neuroepithelial tumors, is characterized by dismal overall survival (OS). Several studies have linked O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation to OS in GBM patients. However, MGMT methylation frequencies vary geographically and across ethnicities, with limited data for South Asian populations, including Pakistan. This study aimed to analyze MGMT promoter methylation in Pakistani GBM patients.

METHODS

Consecutive primary GBM patients diagnosed ≥ 18 years-of-age, with no prior chemotherapy or radiotherapy history, were retrospectively selected. DNA was isolated from formalin-fixed-paraffin-embedded tissues. MGMT promoter methylation was analyzed using methylation-specific PCR. Clinical, pathological, and treatment data were assessed using Fisher's exact/Chi-squared tests. OS was calculated using Kaplan-Meier analysis in SPSS 27.0.1.

RESULTS

The study included 48 GBM patients, comprising 38 (79.2%) males and 10 (20.8%) females. The median diagnosis age was 49.5 years (range 18-70). MGMT methylation was observed in 87.5% (42/48) of all cases. Patients with MGMT methylation undergoing radiotherapy or radiotherapy plus chemotherapy exhibited significantly improved median OS of 7.2 months (95% CI, 3.7-10.7; P < 0.001) and 16.9 months (95% CI, 15.9-17.9; P < 0.001), respectively, compared to those undergoing surgical resection only (OS: 2.2 months, 95% CI, 0.8-3.6).

CONCLUSION

This is the first comprehensive study highlighting a predominance of MGMT methylation in Pakistani GBM patients. Furthermore, our findings underscore the association of MGMT methylation with improved OS across diverse treatment modalities. Larger studies are imperative to validate our findings for better management of Pakistani GBM patients.

Bone pathology mimicking non-accidental injury in a child - Bewildered by bones, case report and review of the literature

INTRODUCTION AND IMPORTANCE

Physical abuse of children is criminal conduct in the purview of medico-legal sciences and the confirmative diagnosis of 'child abuse' is imperative for further legal proceedings. Clinicians play a pivotal role in the protection of children by recognizing and reporting such cases and treating the victims of abuse.

PRESENTATION OF CASE

To the best of our knowledge, we present the first case report in literature where osteofibrous dysplasia resulted in a pathological fracture in a 10-month-old South-Asian child which resembled the picture of child abuse.

CLINICAL DISCUSSION

The challenges faced by clinicians in the process of analysis of presumed child abuse are numerous and careful formulation and elimination of medical conditions which may mimic non-accidental injury (NAI) is a must, prior to making an incontrovertible diagnosis.

CONCLUSION

The telltale signs of NAI such as soft tissue injuries and fractures in a victimized child should always be evaluated cautiously with the intent of excluding pathologies that may mimic them and the evidence in this regard is seldom in literature.

South Asian medical cohorts reveal strong founder effects and high rates of homozygosity

The benefits of large-scale genetic studies for healthcare of the populations studied are well documented, but these genetic studies have traditionally ignored people from some parts of the world, such as South Asia. Here we describe whole genome sequence (WGS) data from 4806 individuals recruited from the healthcare delivery systems of Pakistan, India and Bangladesh, combined with WGS from 927 individuals from isolated South Asian populations. We characterize population structure in South Asia and describe a genotyping array (SARGAM) and imputation reference panel that are optimized for South Asian genomes. We find evidence for high rates of reproductive isolation, endogamy and consanguinity that vary across the subcontinent and that lead to levels of rare homozygotes that reach 100 times that seen in outbred populations. Founder effects increase the power to associate functional variants with disease processes and make South Asia a uniquely powerful place for population-scale genetic studies.

Comparison of Distally Based Sural Fasciocutaneous Island Flap with a nd without Inclusion of Sural Nerve

Objectives: To compare the inclusion and exclusion of the sural nerve in fascio-cutaneous flap repair for lower extremity reconstruction in terms of flap survival, flap size, recovery of skin sensation and complications. Study Design: Prospective comparative study Place and Duration of Study: Department of Plastic Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Jul 2017 to Mar 2020.Methodology: A total of 54 patients (27 in each Group) requiring distal lower limb flap reconstruction and meeting the inclusion and exclusion criteria were included. Patients with a higher probability of flap complications and those with complications during the procedure were excluded. Group-A patients underwent fascio-cutaneous flap repair with sural nerve preservation, while Group-B patients underwent the same technique, but the sural nerve was transected and raised with the flap. All patients were followed for flap survival, flap size and degree of sensory recovery and flap-related complications. Results: Varying degrees of return of sensation were seen in 25(92.6%) patients of Group-A after six months, which was 23(63.1%) in Group-B (p<0.001). Flap survival was comparable in both groups: 26(96.3%) and 25(92.6%) patients in Groups A and B, respectively (p=0.552). The complications were also comparable, 4(14.8%) in Group-A and (25.9%) in Group-B, which was not statistically significant (p=0.209). Conclusion: Preservation of the sural nerve results in little or no sensory loss in the lateral part of the foot, with complication rates and flap survival comparable to cases where the nerve is sacrificed.Keywords: Distally based sural fascio-cutaneous Flap, Distal lower limb flap coverage, Sural nerve preservation.

Surgical management of stricture urethra in patients with chronic renal failure: Ten years' experience at a tertiary center

Introduction

Patients suffering from stricture urethra and deranged renal function have poor quality of life. The incidence of urethral stricture co-existing with renal failure is comparatively small and cause may be multifactorial. There is paucity of literature on management of urethral stricture associated with deranged renal function. We present our experience of managing stricture urethra associated with chronic renal failure.

Materials and Methods

This was a retrospective study conducted from 2010 to 2019. Patients with stricture urethra and deranged renal function (serum creatinine >1.5 mg/dl) who underwent urethroplasty or perineal urethrostomy were included in our study. A total of 47 patients met the inclusion criteria and were included in this study. Patients were followed every 3 months in their 1st year of surgery and 6 monthly thereafter. Statistical analysis was done using SPSS version 16.

Results

There was a significant increase in the mean postopérative maximum and average urinary flow rates when compared to the preoperative values. The overall success rate was 76.59%. Out of 47 patients, 10 had wound infection and delayed wound healing, 2 patients developed ventricular arrhythmias, 6 patients developed fluid and electrolyte imbalance, 2 patients developed seizures, and 1 patient developed septicemia in the postoperative period.

Conclusion

Prevalence of patients with chronic renal failure associated with stricture urethra was 4.58% and features suggestive of deranged renal function at presentation were present in 1.81% patients. In the present study, complications related with chronic renal failure occurred in 17 (36.17%) patients. Multidisciplinary care of the patient along with appropriate surgical management is a viable option in this sub-group of patients.

Synthesis, X-ray diffraction analysis, quantum chemical studies and α-amylase inhibition of probenecid derived S-alkylphthalimide-oxadiazole-benzenesulfonamide hybrids

Sulphonamide and 1,3,4-oxadiazole moieties are present as integral structural parts of many drugs and pharmaceuticals. Taking into account the significance of these moieties, we herein present the synthesis, single-crystal X-ray analysis, DFT studies, and α-amylase inhibition of probenecid derived two S-alkylphthalimide-oxadiazole-benzenesulfonamide hybrids. The synthesis has been accomplished in high yields. The final structures of both hybrids have been established completely with the help of different spectro-analytical techniques, including NMR, FTIR, HR-MS, and single-crystal X-ray diffraction analyses. In an effort to confirm the experimental findings, versatile quantum mechanical calculations and Hirshfeld Surface analysis have been performed. α-Amylase inhibition assay has been executed to investigate the enzyme inhibitory potential of both hybrids. The low IC50 value (76.92 ± 0.19 μg/mL) of hybrid 2 shows the good α-amylase inhibition potential of the respective compound. Ultimately, the binding affinities and features of the two hybrids are elucidated utilising a molecular docking technique against the α-amylase enzyme.

Molecular duplexes featuring NH···N, CH···O and CH···π interactions in solid-state self-assembly of triazine-based compounds

Synthetic supramolecular structures constructed through the cooperative action of numerous non-covalent forces are highly desirable as models to unravel and understand the complexity of systems created in nature via self-assembly. Taking advantage of the low cost of 2,4,6-trichloro-1,3,5-triazine (cyanuric chloride) and the sequential nucleophilic substitution reactions with almost all types of nucleophiles, a series of six structurally related novel s-triazine derivatives 1-6 were synthesized and structurally characterized based on their physical, spectral and crystallographic data. The solid-state structures of all the six compounds showed intriguing and unique molecular duplexes featuring NH···N, CH···O and CH···π interactions. Careful analysis of different geometric parameters of the involved H-bonds indicates that they are linear, significant and are therefore responsible for guiding the three-dimensional structure of these compounds in the solid state. The prevalence of sextuple hydrogen bond array-driven molecular duplexes and the possibility of structural modifications on the s-triazine ring render these novel triazine derivatives 1-6 attractive as a platform to create heteroduplex constructs and their subsequent utility in the field of supramolecular chemistry and crystal engineering.

Effect of Serum Level of Human Epididymis Protein 4 and Interleukin-6 as Biomarkers in Patients with Adnexal Mass

Ovarian carcinoma is one of the most common types of neoplasms in women and the fifth leading cause of cancer death among women worldwide. Adnexal masses are classified as simple or complicated and can be benign or malignant. No single biomarker has demonstrated high sensitivity and specificity for detecting early ovarian cancer. Therefore, the current study was designed to investigate the influence of using two biomarkers as a tool for diagnosis in patients with an adnexal mass. This prospective case-control study was carried out on female patients diagnosed by ultrasound and magnetic resonance imaging with adnexal masses and scheduled for surgery and healthy women as a control group (n=50 each). The patients were in the age range of 16-80 years old and had attended the surgical rooms of Basrah hospitals, Basrah, Iraq, from January to July 2021. The levels of serum biomarkers were quantitatively assessed using the enzyme-linked immunosorbent assay. The serum concentration of the human epididymis protein 4 (HE4) biomarker exhibited significant differences between females with adnexal mass and healthy women. There was no significant association between neither the patient's age nor the menopausal state and the serum level of HE4. The serum level of HE4 had a sensitivity of 92% and a specificity of 66% as a serum marker for the presence of adnexal mass with a positive predictive value of 73% and a negative predictive value of 89%. In this study, serum interleukin-6 (IL-6) had a sensitivity of 30% and specificity of 64% in determining patients with adnexal mass pathology. It was found that the level of IL-6 was similar in all patients, compared to that in the control group. The median levels of serum HE4 showed high value in patients in the age groups of 21-40, 41-50, and >50 than in the control group; however, it was not statistically different (P=0.413). Human epididymis protein 4 was the top biomarker representing a higher concentration in adnexal mass; moreover, it demonstrated the highest performance in all samples with Adnexal mass. The results of our study showed that combining more than one marker measurement increased both the sensitivity and specificity of distinguishing patients with adnexal mass pathology.

Detection of Salmonella spp. by Traditional and PCR Assays in Raw Milk, Maysan, Iraq

Salmonella spp are characterized as rod- shaped, motile, gram- negative bacteria which has the ability to infect animals and human. Salmonella spp occasionally causes sickness while in most cases not lead to severe symptoms. Analyzing milk for Salmonella spp. is not routine but traditional culture methods are used to evaluate the health condition of the dairy products. However, the antibody-based and nucleic-acid- based methods are practical for identifying Salmonella spp. Therefore, this research was designed to evaluate the use of traditional culture methods and PCR in detection of the presence of Salmonella spp. in raw milk samples in, Maysan Iraq. A total number of 130 raw milk samples collected from Maysan Iraq. All the samples were analyzed for the presence of Salmonella spp. using traditional culture method and polymerase chain reaction (PCR). The culture method used in this experiment were done by using pre-enrichment, enrichment, selective plating and biochemical tests. The results of this traditional technique were compared with the results obtained from PCR method. The PCR was performed using a 284bp sequence of the invA gene. The results showed that 8 (7.07%) of samples were identified as salmonella positive using traditional culture technique but 14 (12.3%) samples were detected as salmonella positive by PCR method. The results of the current research revealed that the traditional culture based methods are generally time costuming and labor intensive but the development of new rapid methods including DNA based methods such as PCR are more sensitive and have dramatically decreased the time necessary for the detection of bacteria.

Ewing Sarcoma of Chest Wall: Analysis of 19 Patients

Objective: To share the short and long term outcomes of the patients having Ewing Sarcoma of the chest wall. Study Design: Prospective longitudinal study. Place and Duration of Study: Thoracic Departments of Combined Military Hospital Rawalpindi, Combined Military Hospital Lahore and Combined Military Hospital Multan from Jan 2010 to Jun 2020. Methodology: In total, 19 patients were enrolled. Inclusion criteria were physiologically fit patients for one-lung ventilation with proven true-cut histopathology. Exclusion criteria were poor performance status and non-compliance to chemotherapy. Results: Out of 19 cases, 13 males (68.42%) and six females (31.58%) patients. The age range was from 8 to 29 years, with a mean age of 17.6 + 4.16 years. The most common symptom was palpable mass 19, followed by chest pain 8 and one patient presented with fungating mass. All patients showed partial response to neo-adjuvant chemotherapy as per RECIST criteria. Following resection and confirmation of negative margins, primary reconstruction was done. The soft tissue coverage was provided using Latissimus Dorsi Muscle Flap in 16 Cases (84.21%) and in 03 patients (15.79%) Rectus Abdominis muscle was used. Post operatively, less than 02 blood transfusions were needed in six patients. There was no post-operative ventilatory support required, and mortality was zero. Conclusion: Ewing Sarcoma of the chest wall is a rare tumour in the adult population. An excellent outcome can be achieved through early diagnosis, meticulous surgical technique and good teamwork in a multi-disciplinary setting.

Comparison of Results After Facial Fat Grafting with Filtered and Washed Fat Versus Centrifuged Fat

Objectives: To compare the centrifuged fat versus filtered and washed fat for facial fat grafting in terms of patient satisfaction and subjective/objective appearance. Study Design: Comparative prospective study. Setting/Duration of Study: Department of Plastic Surgery, CMH, Rawalpindi Pakistan, from Aug 2017 to Jan 2020. Methodology: A total of 64 patients (32 in each group) requiring facial fat grafting who fulfilled the sample selection criteria were included in the study. Patients who had received facial cosmetic surgery previously had systemic comorbid or were suffering from active infections were excluded. Group-A patients received centrifuged fat grafts, while Group-B patients received filtered and washed fat grafts. All patients were followed for patient satisfaction and subjective/objective appearance. Results: In Group-A, 23 (71.9%), 3 (9.4%), and 6 (18.7%) patients were happy, just satisfied and unhappy with the overall results of the procedure, respectively, while these numbers were 25 (78.1%), 3 (9.4%), and 4 (12.5%) in Group-B (p=0.785). Patients’ evaluation of their general appearance post-procedure (scored out of 10) showed a mean score of 6.53 ± 2.46 in Group-A and 6.72 ± 2.19 in Group-B (p=0.749). Scoring for a general appearance by an expert panel showed a mean score of 6.72 ± 2.16 in Group-A and a mean score of 7.13 ± 1.81 in Group-B (p=0.418). Conclusion: There is no difference between centrifugation and filtration/washing of fat grafts for facial grafting regarding patient satisfaction and subjective/objective appearance.

Comparison of Outcomes Following Syndactyly Release with Grafts and Without Grafts

Objective: To compare the results of syndactyly release with or without graft in patients with simple syndactyly of hand. Study Design: Prospective comparative study. Place and Duration of Study: Department of Plastic Surgery, Combined Military Hospital Rawalpindi Pakistan, from Jul 2017 to Jun 2019 Methodology: Forty-five patients with simple syndactyly were included in this study. Group-1 had 20 patients whose syndactyly was released without using a skin graft. Group-2 had 25 patients whose soft tissue was covered with a fullthickness skin graft between the flaps post syndactyly release. Both groups were compared based on operative time, wound healing time, and when physiotherapy was started post operatively. Results: The results of our study showed that the mean operative time for the first group was 47.1 ± 4.5 minutes (range 35-60 minutes) and for the second group 90.5 ± 10.0 minutes (range 72-108 minutes) with a p-value <0.001. The wound healing time for the first group was 15.2 ± 1.3 days (12-18 days’ range) and for the second group was 22.5 ± 5.1 days (range 14-30 days) with a p-value <0.001. Post-operative physiotherapy was started earlier in the first group with an average of 20.6 ± 1.3 days (18-22 days’ range) as compared to the second group whose average time of the start of physiotherapy was 27.7 ± 4.4 days (range 20- 35 days) with p-value <0.001. Conclusion: Syndactyly release without a skin graft has a lesser operative time, early wound healing and an earlier start of physiotherapy than syndactyly release with......

Role of Magnetic Resonance Neurography on 3-Tesla in Brachial Plexus Injury Management

Objective: To study the effect of magnetic resonance neurography on 3 Tesla (MRN-3T) on the outcome of brachial plexus injury management. Study Design: Prospective comparative study.Place and Duration of Study: Department of Plastic Surgery, Combined Military Hospital Rawalpindi Pakistan, from Apr 2017 to Mar 2019. Methodology: Two groups of brachial plexus injury (BPI) were studied over two years. Group-A (n=29) cases whose operative intervention was decided based on history, examination, NCS/EMG and CT scan. Second group-B included (n=33) patients in which MRN-3T (magnetic resonance neurography on 3 Tesla) was the critical diagnostic tool. The comparison of preoperative diagnosis with intraoperative findings and outcome of surgery were made. Results: Out of 29 cases in group-A, 11 (37.93%) were explored. In these 11, neurolysis was done in one case, direct repair in one case, nerve grafting in 4 patients, nerve transfers with bridging grafts in 2 cases, whereas three patients had negative exploration. Of 33 cases in group-B, 21(63.64%) were explored. From these 21 cases, neurolysis was done in four patients; the direct repair was possible in 7 and in 10 cases bridging nerve grafts were used along with primary nerve transfers. Conclusion: MRN-3T brachial plexus has significantly improved the diagnosis, preoperative planning and surgical outcome of patients with brachial plexus injury.

Uniaxial Strain Control of Bulk Ferromagnetism in Rare-Earth Titanates

The perovskite rare-earth titanates are model Mott insulators with magnetic ground states that are very sensitive to structural distortions. These distortions couple strongly to the orbital degrees of freedom and, in principle, it should be possible to tune the superexchange and the magnetic transition with strain. We investigate the representative system (Y,La,Ca)TiO_{3}, which exhibits low crystallographic symmetry and no structural instabilities. From magnetic susceptibility measurements of the Curie temperature, we demonstrate direct, reversible, and continuous control of ferromagnetism by influencing the TiO_{6} octahedral tilts and rotations with uniaxial strain. The relative change in T_{C} as a function of strain is well described by ab initio calculations, which provides detailed understanding of the complex interactions among structural, orbital, and magnetic properties in rare-earth titanates. The demonstrated manipulation of octahedral distortions opens up far-reaching possibilities for investigations of electron-lattice coupling, competing ground states, and magnetic quantum phase transitions in a wide range of quantum materials.

Access to health care for people with stroke in South Africa: a qualitative study of community perspectives

Background

Incidence of stroke is increasing in sub-Saharan Africa. People who survive stroke experience disability and require long-term care. Health systems in South Africa (SA) are experiencing important challenges, and services in the public health system for people with stroke (PWS) are fragmented. We aimed to explore the perspectives and experiences of PWS related to stroke care services to inform health system strengthening measures.

Methods

In-depth interviews with 16 PWS in urban and rural areas in the Western and Eastern Cape Provinces of SA were conducted between August and October 2020. PWS were recruited through existing research networks, non-government organisations and organisations of persons with disabilities by snowball sampling. Interviews were transcribed, coded, and thematically analysed. We used the conceptual framework of access to health care as proposed by Levesque et al. to map and inform barriers to accessing health care from the user perspective.

Results

PWS recognised the need for health care when they experienced signs of acute stroke. Health literacy on determinants of stroke was low. Challenges to accessing stroke care include complex pathways to care, physical mobility related to stroke, long travel distances and limited transport options, waiting times and out of pocket expenses. The perceived quality of services was influenced by cultural beliefs, attitudinal barriers, and information challenges. Some PWS experienced excellent care and others particularly poor care. Positive staff attitude, perceived competence and trustworthiness went in hand with many technical and interpersonal deficits, such as long waiting times and poor staff attitude that resulted in poor satisfaction and reportedly poor outcomes for PWS.

Conclusions

Strategic leadership, governance and better resources at multiple levels are required to address the unmet demands and needs for health care of PWS. Stroke care could be strengthened by service providers routinely providing information about prevention and symptoms of stroke, treatment, and services to patients and their social support network. The role of family members in continuity of care could be strengthened by raising awareness of existing resources and referral pathways, and facilitating connections within services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07903-9.

Analyzing human knockouts to validate GPR151 as a therapeutic target for reduction of body mass index

Novel drug targets for sustained reduction in body mass index (BMI) are needed to curb the epidemic of obesity, which affects 650 million individuals worldwide and is a causal driver of cardiovascular and metabolic disease and mortality. Previous studies reported that the Arg95Ter nonsense variant of GPR151, an orphan G protein-coupled receptor, is associated with reduced BMI and reduced risk of Type 2 Diabetes (T2D). Here, we further investigate GPR151 with the Pakistan Genome Resource (PGR), which is one of the largest exome biobanks of human homozygous loss-of-function carriers (knockouts) in the world. Among PGR participants, we identify eleven GPR151 putative loss-of-function (plof) variants, three of which are present at homozygosity (Arg95Ter, Tyr99Ter, and Phe175LeufsTer7), with a cumulative allele frequency of 2.2%. We confirm these alleles in vitro as loss-of-function. We test if GPR151 plof is associated with BMI, T2D, or other metabolic traits and find that GPR151 deficiency in complete human knockouts is not associated with clinically significant differences in these traits. Relative to Gpr151+/+ mice, Gpr151-/- animals exhibit no difference in body weight on normal chow and higher body weight on a high-fat diet. Together, our findings indicate that GPR151 antagonism is not a compelling therapeutic approach to treatment of obesity.

Enhanced superconductivity and ferroelectric quantum criticality in plastically deformed strontium titanate

The properties of quantum materials are commonly tuned using experimental variables such as pressure, magnetic field and doping. Here we explore a different approach using irreversible, plastic deformation of single crystals. We show that compressive plastic deformation induces low-dimensional superconductivity well above the superconducting transition temperature (T_c) of undeformed SrTiO₃, with evidence of possible superconducting correlations at temperatures two orders of magnitude above the bulk T_c. The enhanced superconductivity is correlated with the appearance of self-organized dislocation structures, as revealed by diffuse neutron and X-ray scattering. We also observe deformation-induced signatures of quantum-critical ferroelectric fluctuations and inhomogeneous ferroelectric order using Raman scattering. Our results suggest that strain surrounding the self-organized dislocation structures induces local ferroelectricity and quantum-critical dynamics that strongly influence T_c, consistent with a theory of superconductivity enhanced by soft polar fluctuations. Our results demonstrate the potential of plastic deformation and dislocation engineering for the manipulation of electronic properties of quantum materials.

Paediatric post-COVID-19 hyperinflammatory syndrome mimicking appendicitis: a case series

INTRODUCTION

A novel hyperinflammatory syndrome has emerged in the paediatric population: paediatric inflammatory multisystem syndrome - temporally associated with SARS-CoV-2 (PIMS-TS). Up to 50% of patients develop shock with cardiac dysfunction but presentation with acute abdominal pain is common and difficult to distinguish from appendicitis.

METHOD

Prospective case series of PIMS-TS patients presenting to a single UK tertiary paediatric centre.

RESULTS

As of 16 September 2020, 89 patients have presented with PIMS-TS to our institution; 19 (21.3%) were referred for surgical review. Pyrexia and acute abdominal pain were seen in all 19 patients. Diarrhoea was reported in 14 (73%) and vomiting in 12 (63%). On examination, eight (42%) had right abdominal tenderness, of which five had right iliac fossa (RIF) peritonism. C-reactive protein (CRP) was universally raised: median 176 (15-463)mg/l. Abdominal imaging was performed in 17 (89%), with 11 undergoing abdominal ultrasonography (65%) and 8 abdominal computed tomography (47%); two required both. Findings included nonspecific features of inflammation in the RIF. Eight patients (42%) had an abnormal echocardiogram at admission. Two (10%) patients, with classical signs and symptoms of appendicitis, underwent appendicectomy without radiological imaging and were subsequently diagnosed with PIMS-TS. During the same period, 18 patients underwent appendicectomy for histologically confirmed appendicitis. Serum CRP and ferritin levels were significantly higher in the PIMS-TS cohort compared with children with appendicitis.

CONCLUSIONS

PIMS-TS is a novel paediatric condition that may mimic appendicitis. It should be considered in patients presenting with abdominal pain to avoid unnecessary surgery in children at risk of cardiovascular instability.

DONOR SITE MORBIDITY OF FIBULAR FLAP

Objective: To present the early and late outcomes related to donor site morbidity of Free Fibular Flap. Study Design: Prospective observational study. Place and Duration of Study: Plastic surgery department, Combined Military Hospital Rawalpindi, from Jan 2009 to Jan 2020. Methodology: In total 361 patients were enrolled for the study through consecutive purposive sampling. All patients requiring free fibula flap for reconstruction of the defect were included in the study. However, the patients with Diabetes Mellitus, Smoking or peripheral vascular disease were excluded from the study. The patients were asked to visit on second week and then at three months for late outcomes. The results were entered SPSS-24 for analysis and interpretation of data. Results: Out of total 361 patients enrolled for study 293 (81.16%) were male and 68 (18.83%) were female. The men age was 51.43 years SD 14.6 (range 4 year to 68 years). In early outcomes, graft loss 29 (8.03%) and sensory deficit 19 (5.26%), are the commonest adverse outcomes. Results of late follow up revealed chronic pain in 29 (8.03%), ankle instability in 24 (6.64%), gait abnormality in 29 (8.76%) and claw toe in 33 (9.14%) patients. The American Orthopedic Foot and Ankle Society (AOFAS) score was 88.45%. Majority (52.63%) patients were very satisfied. Conclusion: The free Fibula is excellent choice for reconstruction of a wide range of osseous defects with minimum donor site morbidity and high satisfaction rate among the patients.Keywords:

Novel coumarin-isatin hybrids as potent antileishmanial agents: Synthesis, in silico and in vitro evaluations

Leishmaniasis being one of the six major tropical diseases that affects nearly 0.7-1.3 million people annually, has so far limited and high toxic therapeutic options. Herein, we report the synthesis, in silico, and in vitro evaluations of novel coumarin-incorporated isatin hydrazones (Spf-1 - Spf-10) as highly potent and safe antileishmanial agents. Molecular docking was initially carried out to decipher the binding confirmation of lead molecules towards the active cavity of the target protein (Leishmanolysin gp63) of Leishmania tropica. Among all the docked compounds, only Spf-6, Spf-8, and Spf-10 showed high binding affinities due to a pattern of strong conventional hydrogen bonds and hydrophobic π-interactions. The molecular dynamics simulations showed the stable pattern of such bonding and structure-based confirmation with a time scale of 50 ns towards the top compound (Spf-10) and protein. These analyses affirmed the high stability of the system. Three out of ten compounds evaluated for their antileishmanial activity against Leishmania tropica promastigotes and amastigotes were found to be active at micromolar concentrations (IC₅₀ range 0.1-4.13 μmol/L), and most importantly, they were also found to be highly biocompatible when screened for their toxicity in human erythrocytes.

SHORT AND LONG TERM FOLLOW UP RESULTS OF (THE VERSATILE) GASTROCNEMIUS MUSCLE FLAP

Objective: To see the long and short term outcome of the Gastrocnemius muscle flap for coverage of soft tissue defects of knee and proximal Tibia. Study Design: Case series. Place and Duration of Study: Surgery Department of Combined Military Hospital Bahawalpur, from Dec 2014 to Oct 2017. Methodology: A total of 33 patients were enrolled for the study through consecutive sampling. Data was processed using SPSS-17. All patients were followed up at first and second week (early morbidity), and then at 06 months (late morbidity) from operation. During early follow up, they were examined for Hematoma at donor site, wound Infection, sural nerve injury, partial skin graft loss and Partial Flap Necrosis. In late follow up patients were examined for reduced Knee mobility and Gastrocnemius muscle contractions. Results: The studied 33 patients consisted of 30 (90.90%) men and 3 (9.09%) women. The mean age was 35 years (range: 16 to 64) years. Hematoma was commonest complication. It occurred in 6.06%. Wound infection, partial loss of flap, partial loss of skin graft and wound infection occurred in 3.03% patients. Late follow up revealed reduced knee mobility in 9.09% patients (n=3) and bothersome contraction of gastrocnemius muscle in same number of patients. Conclusion: The gastrocnemius flap is reliable, versatile, and very useful for provision of supple soft tissue coverage for defects around the knee and the upper leg.

Understanding the planar conformations in diarylsubstituted heteroarenes: structural and theoretical insights

We have synthesized and X-ray characterized a series of six diaryl-substituted heteroarenes in order to analyze unconventional intramolecular C_Ar–H⋯N/O in comparison to conventional H-bonds.

Crystal engineering with pyrazolyl-thiazole derivatives: structure-directing role of π-stacking and σ-hole interactions

The structure-directing role of a variety of noncovalent interactions in the solid state of pyrazolyl-thiazole derivatives has been analyzed energetically using DFT calculations and by means of Hirshfeld surface analysis.

Prevalence of common mental disorders among Syrian refugee children and adolescents in Sultanbeyli district, Istanbul: results of a population-based survey

AIMS

Research demonstrates elevated levels of common mental disorders among Syrian refugees, but the majority of studies have, to date, focused on adult populations. This study aims to estimate the prevalence of depression, anxiety and post-traumatic stress disorder (PTSD) among Syrian children and adolescents living in Sultanbeyli district of Istanbul, Turkey.

METHODS

A population-based survey among Syrian children and adolescents aged 8-17 years living in Sultanbeyli district was conducted in 2019, as part of an all-age survey of disability. 80 clusters of 50 participants (all-ages) were selected from the local municipality's refugee registration database using probability proportionate to size sampling. Children aged 8-17 years were assessed for symptoms of common mental disorders using the Child Revised Impact of Event Scale (CRIES-8) and abbreviated versions of the Center for Epidemiologic Studies Depression Scale for Children (CES-DC) and the Screen for Child Anxiety Related Disorders (SCARED).

RESULTS

Of the 852 participants, 23.7% (95% CI 19.9-27.2) screened positive for symptomatic depression, PTSD and anxiety. The prevalence estimates for depression, PTSD and anxiety were 12.5% (95% CI 9.8-15.6), 11.5% (95% CI 9.1-14.4) and 9.2% (95% CI 6.8-12.1), respectively. Depression and PTSD were significantly more common in older adolescents, whilst anxiety and PTSD were significantly more common in girls. Depression was more common in children from poorer households and those who had received no education. Children coming from larger households were less likely to show symptoms of PTSD.

CONCLUSIONS

Syrian refugee children and adolescents are vulnerable to common mental disorders, and culturally appropriate prevention and intervention support are needed for this population.

Reconstruction Of Segmental Mandibular Loss With Vascularized Free Fibula Flapsn

BACKGROUND

Various methods for mandibular reconstruction have been demonstrated in literature from autogenous bone graft to free flaps and more recently tissue engineered materials. We share our experience of mandibular reconstruction with free fibular flap and evaluate its efficiency as a viable option for mandibular reconstruction.

METHODS

It was a cross-sectional study, conducted at Plastic surgery department combined military hospital, Rawalpindi. Study was carried out over a period of two years from November 2016 to November 2018. The data of demography, mode of presentation, pattern of reconstruction and procedural complications of the patients who underwent free fibula flap for segmental mandibular loss, were collected and analysed. Patients with segmental loss of mandible ranging from 6 to 15 cm and those who could sustain surgery were included in the study, while the patients with metastatic malignancy and recurrent disease were excluded from the study. Each patient was called for first follow up after 2 weeks then subsequent follow up after 1 month. Descriptive statistics were done with the help of SPSS-20.

RESULTS

A total of 57 patients with segmental mandibular loss treated with free fibula flap, fulfilling inclusion and exclusion criteria were included in this study. Thirtyeight patients were male while 19 were female with mean age 56±3 years. Cause of mandibular loss was malignancy in 52 (91.2%), trauma in 3 (5.2%), and ameloblastoma in 2 (3.5%) patients. Major complications like flap failure was seen in one (1.75%), bone exposure in 1 (1.75%) and recurrence was observed in 1 (1.75%) patient. Minor complications like hematoma, wound dehiscence and oro-cutaneous fistula were seen in 2, 1 and 3 patients respectively.

CONCLUSIONS

Free fibular flap shows good functional results with a high degree of consistency, and acceptable complications rate, so it should be the first choice for mandibular reconstruction.

Discovery of 318 new risk loci for type 2 diabetes and related vascular outcomes among 1.4 million participants in a multi-ancestry meta-analysis

We investigated type 2 diabetes (T2D) genetic susceptibility via multi-ethnic meta-analysis of 228,499 cases and 1,178,783 controls in the Million Veteran Program, DIAMANTE, Biobank Japan, and other studies. We report 568 associations, including 286 autosomal, 7 X chromosomal, and 25 identified in ancestry-specific analyses that were previously unreported. Transcriptome-wide association analysis detected 3,568 T2D-associations with genetically predicted gene expression in 687 novel genes; of these, 54 are known to interact with FDA-approved drugs. A polygenic risk score was strongly associated with increased risk of T2D-related retinopathy and modestly associated with chronic kidney disease (CKD), peripheral artery disease (PAD), and neuropathy. We investigated the genetic etiology of T2D-related vascular outcomes in MVP and observed statistical SNP-T2D interactions at 13 variants, including coronary heart disease, CKD, PAD, and neuropathy. These findings may help to identify potential therapeutic targets for T2D and genomic pathways that link T2D to vascular outcomes.

Repurposing of respiratory drug theophylline against Candida albicans: mechanistic insights unveil alterations in membrane properties and metabolic fitness

AIMS

Drug repurposing is an attractive chemotherapeutic strategy that serves to make up for the inadequacy of current antifungal drugs. The present study aims to repurpose theophylline (THP) against Candida albicans. THP is a methylxanthine derived from cocoa beans and tea extracts, generally used as the first-line drug for asthma and other respiratory disorders.

METHODS AND RESULTS

We investigated the antifungal activity of THP against C. albicans and non-albicans species. Mechanistic insights revealed that THP induces membrane damage. Enhanced ionic disturbances and depleted ergosterol levels with the concomitant rise in membrane fluidity due to elevated flippase activity confirmed the membrane damaging effect. THP impeded the metabolic adaptability of C. albicans by inhibiting malate synthase and isocitrate lyase enzymes of the glyoxylate cycle. In vivo efficacy of THP was depicted by increased survival of C. albicans infected Caenorhabditis elegans model.

CONCLUSIONS

This study elucidates the antifungal potential of THP with mechanistic insights.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study unveils the antifungal potential of THP, a known respiratory drug that can be further utilized for a wider range of applications such as combating fungal infections. The effect of THP with the known antifungal drugs can be exploited in the combinatorial drug approach for treating candidiasis.

Synthesis and evaluation of novel S-benzyl- and S-alkylphthalimide- oxadiazole -benzenesulfonamide hybrids as inhibitors of dengue virus protease

Direct acting antiviral drugs (DAADs) are becoming therapeutics of choice for the treatment of viral infections. Successful development of anti HIV and HCV drugs by targeting the viral proteases has provided impetus for discovering newer DAADs. Dengue virus (DENV) protease, which is composed of two nonstructural proteins, NS2B and NS3pro, can be likewise exploited for discovering new anti-dengue therapeutics. In this study, we have linked together two pharmaceutically interesting motifs, namely 1,3,4-oxadiazole and benzenesulfonamide in two alternative series to develop novel S-benzylated and S-alkylphthalimidated hybrids. For the first series of hybrids, 4-aminobenzoic acid (1) was reacted with substituted benzenesulfonyl chlorides via its amino group, whereas the carboxylic acid side was elaborated to sulfonamido-1,3,4-oxadiazole-2-thiols (6a/b) in three steps. At this stage, the intermediates 6a/b were bifurcated to either S-alkylphthalimidated (8a-j) or S-benzylated (9a-c) hybrids by reacting with corresponding halides. For the alternative series of hybrids, the carboxylic acid group of probenecid (10) was similarly elaborated to sulfonamido-1,3,4-oxadiazole-2-thiols (13), and diverged to S-alkylphthalimidated (14a-f) and S-benzylated hybrids (15a-e). Bioactivity assays demonstrated that 8g and 8h are the most potent inhibitors among the synthesized analogs, exhibiting the IC50 values of 13.9 μM and 15.1 μM, respectively. Computational assessment predicted the binding of the inhibitors at an allosteric site developed in the open conformation of DENV2 NS2B/NS3pro. Taken together these findings point out that the synthesized hybrid inhibitors possess a great potential for further antiviral drug development.

Recurrent π–π stacking motifs in three new 4,5-dihydropyrazolyl–thiazole–coumarin hybrids: X-ray characterization, Hirshfeld surface analysis and DFT calculations

Two different π–π stacking modes are described, studied and characterized in the crystal structures of 4,5-dihydropyrazolyl–thiazole–coumarin hybrids, including a partial aliphatic ring.

Cytotoxicity, Pro-apoptotic Activity and in silico Studies of Dithiocarbamates and their Structure Based Design and SAR Studies

Background:

Cancer is a far-reaching and lethal but curable disease. Researchers have investigated numerous anticancer agents with only a few commercially available effective drugs which are very costly.

Objective:

Herein, we report the synthesis , characterization and anti cancer assays of a series of novel dithiocarbamates derivatives.

Methods:

All compounds were synthesized from different secondary amines and substituted benzyl chlorides in a single step. The structures of newly synthesized dithiocarbamate derivatives were confirmed by spectroscopic techniques (IR, NMR and HR-MS).

Results:

The synthesized compounds showed a significant anti-proliferative effect in cancer cells (HeLa) with the maximum inhibitory activity of compound SHD-2 with an IC50 = 0.31 ± 0.09 μM. However, the same compound exhibited 19.2% inhibition towards Baby Hamster Kidney fibroblasts (BHK-21), normal cell lines. Moreover, quantification of cellular DNA by flow cytometry for the evaluation of pro-apoptotic activity in HeLa cells demonstrates that arrest in cell cycle along with apoptosis advance towards drug cytotoxicity. However, molecular docking studies of the potent compound suggested that it binds to the major groove of the DNA.

Conclusion:

The cytotoxic and pro-apoptotic potential of the potent inhibitor may be further investigated in the animal models to advance their anti-cancer prospective.

C-39 Utility of Addenbrooke's Cognitive Exam III (Singapore-Chinese Version) for Cognitive Screening and Correlation with Standardized Neuropsychological Tests

Objective

Dementia is a public health priority worldwide. Early screening of cognitive impairment and locating of specific impaired areas are essential for timely intervention and prolonging independence. The commonly-used Mini Mental State Examination (MMSE) is inadequate. Alternatively, the Addenbrooke's Cognitive Exam III (ACE-III) that assesses five domains (attention, memory, verbal fluency, language and visuospatial abilities) is recommended.

Thus, we aim to examine the utility of Singapore-Chinese version (ACE-III-SG-C) for case finding of cognitive impairment, and its correlation with the respective standardized neuropsychological tests.

Methods

22 participants were referred by neurologists for comprehensive neuropsychological assessment at public healthcare institution. Participants were categorized into three groups (No Cognitive Impairment, NCI: 6; Mild Cognitive Impairment, MCI: 9; Dementia: 7). The ACE-III-SG-C and MMSE were administered. ACE-III-SG-C total and individual domain scores were computed.

Results

No significant difference in age and education across three groups. The MMSE scores (F(2,19) = 5.005, p = .018) and ACE-III-SG-C total scores (F(2,19) = 21.296, p < 0.001) were significantly different across three groups. Post hoc comparisons indicated that dementia (p < .001) and MCI (p = 0.046) groups had significantly lower ACE-III-SG-C total scores than NCI group. However, the MMSE scores of the MCI and NCI groups were comparable (p = 0.850). The Modified Boston Naming Test were significantly correlated with ACE-III-SG-C language domain scores (r = .605, p = .003), but not MMSE (r = .400, p = .065).

Conclusions

ACE-III-SG-C demonstrated its usefulness for early screening of MCI and dementia. Its correlation with language test suggested potential detection for disorders with language impairment. Further research is needed to unravel its utility of describing other specific impaired areas.

Diverse structural assemblies of U-shaped hydrazinyl-sulfonamides: experimental and theoretical analysis of non-covalent interactions stabilizing solid state conformations

The preparation and structures of five new U-shaped hydrazinyl-sulfonamides are reported.

Carbonic Anhydrase Inhibitory Potential of 1,2,4-triazole-3-thione Derivatives of Flurbiprofen, Ibuprofen and 4-tert-butylbenzoic Hydrazide: Design, Synthesis, Characterization, Biochemical Evaluation, Molecular Docking and Dynamic Simulation Studies

BACKGROUND

The over-expression of the carbonic anhydrases results in some specific carcinomas including pancreatic, gastric and brain tumor. Tumors are distinguished under hypoxic conditions and various investigations are being carried out to target the known hypoxic areas of the tumors to increase the sensitivity towards standard therapeutic treatment.

OBJECTIVE

Herein, we have designed and synthesized some biologically important esters, hydrazides, thiocarbamates, 1,2,4-triazole-3-thiones and Schiff bases. The purpose of the research was to evaluate the derivative against carbonic anhydrase and to assess the toxicity of the same compounds.

METHOD

The structures of all the compounds were characterized by FT-IR, mass spectrometry, elemental analysis, 1H and 13C NMR spectroscopy. The synthetic derivatives were screened for their inhibitory potential against carbonic anhydrase II by in vitro assay. Double reciprocal plots for inhibition kinetics of the potent compounds were constructed and mode of inhibition was determined. Furthermore, to check the cytotoxicity, these derivatives were tested against human breast adenocarcinoma by MTT method.

RESULTS

X-ray diffraction analysis of the compounds 10, 14 and 15 showed that they did not have any π-π or C-H…π interactions. The experimental results were validated by molecular docking and dynamic simulations of the potent compounds in the active pocket of enzyme. Important binding interactions of potent compounds with the key residues in the active site of the carbonic anhydrase enzyme were revealed. Drug likeness profile of the derivatives was evaluated to determine the physicochemical properties.

CONCLUSION

The proposed synthetic approach provides a suitable platform for the generation of a new library of compounds which could potentially be employed in the future testing and optimization of inhibitor potencies.